Prevention of low back pain

Most of the previous reviews on preventing low back pain (LBP) have major limitations. The aim of this high-quality systematic review was to document the evidence for interventions relating to LBP and sick leave because of LBP. Twenty-three reports (21 different RCTs including 30,850 unique participants) were included in this review.

The results of this systematic review and meta-analysis indicate the following:

Exercise and education combined may reduce the risk of LBP

Exercise alone may reduce the risk of an episode of LBP and sick leave. Uncertainty of whether the effects persist beyond 1 year however exists.

Education alone, back belts, shoe insoles, and ergonomic adjustments do not seem to prevent LBP or sick leave due to LBP.

Uncertainty exists whether education, training, or ergonomic adjustments are able of preventing LBP due to very low quality of evidence.

The review found documentation for exercise alone reducing LBP episodes by 35% and sick leave by 78%. The review also showed that exercise and education reduced the risk for LBP by 45% and prevented LBP for up to 1 year. The effect sizes were however very much reduced for periods of over 1 year. This important finding suggests that ongoing exercise is necessary and that program focusing on long-term behavior changes as to exercise may be important.

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